We’re still learning the costs of Trump’s gag rule on abortions

A long way to go.
A long way to go.
Image: Reuters/Jose Cabezas
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Four years ago, two actions US president Donald Trump took soon after taking office effectively cut reproductive health funding for developing countries.

He did this by completely cutting US funding to the United Nations Population Fund (UNFPA), which received a budget of about $32 million a year from the US government, and by imposing the so-called Global Gag Rule, which was first introduced in 1984, only to be removed by each Democratic administration and reinstated by each Republican one since. The rule withholds US foreign aid money to non-governmental organizations that provide abortions and abortion counseling.

Today, Joe Biden dropped the rule, alongside a similar one that applies to domestic organizations. The administration plans to fund UNFPA, too. But the damage done in the past four years has been significant.

The US is the biggest donor of international aid devoted to reproductive health—the budget devoted to it by Congress for the four years of Trump administration was $9.5 billion. US law forbids any organization receiving federal funds from using them to perform abortions. But with the gag rule in place, even organizations that use US funds to provide reproductive health services—such as contraception and gynecological care—but would perform abortions or give abortion counseling with other lines of revenue, are banned from any American funding.

The version of the gag rule imposed by Trump was stricter than those of his predecessors, and its damages on reproductive health services more severe.

A conservative estimate by the US Government Accountability Office found that in the first two years of the gag rule, about $153 million of US funds remained unawarded as a consequence of the gag rul. That’s in addition to the more than $120 million that were denied to UNFPA, which provides reproductive and women’s healthcare to developing countries and emergency settings, over four years.

But the true damage extends far beyond the money lost, and to the services that weren’t provided to women, who are the primary receivers of reproductive health services.

An estimated 26 million women worldwide lost access to safe abortions, as the organizations that provided them either had to close or stop performing abortions in order to receive US funds. Unsafe abortions are the leading cause of maternal mortality, accounting for 15% of deaths.

But the effects of the rule went far beyond denied abortions. As the African Population and Health Research Center found in its research, the gag rule caused reductions in HIV/AIDS prevention services, contraceptive care, and even maternal health treatments. Those services have yet to recover, as it will take time for Biden’s change of policy to affect the work done on the ground.

Arguably even more damaging has been the disruption of many local healthcare systems. Particularly in rural areas, reproductive care organizations are often a key partner in maintaining overall community health, and left gaps in care where they were forced to close or reduce their services. This is especially worrisome during a pandemic, especially since the Trump administration demanded that reproductive health was not included in international aid devoted to Covid-19 relief.